Toric lens cataract surgery led to increased and still increasing astigmatism

[royster]

(A) With Surgery day as Day 0, and using the Negative cylinder convention, these are some data points for  Sphere, Cylinder and Axis for  my LEFT eye :
1.  Day negative 45, from Long standing optometrist :   :   -9.50   -2.25  162
2.   Day  +8 from Surgeon : :  +1.75  -3.25  170
3.  Day +12 from long standing optometrist ::   +2.50   -4.00   164
4.  Day +16 from USC Eye Clinic :    +2.50  -4.25  165
5.  Today  Day +20, With the right eye completely covered or closed, I see multiple visions when trying to read
through my left eye, and all ranges of over the counter reading glasses fail.
(B)  Day Zero surgery   Acry Sof iQ TORIC  via  Alcon
       Model  SN6AT5   POWER :  7.0 D   3.00 CYL
      Length 13.0 mm   Optic  6.00 mm
      UV With Blue Light Filter .  
(C)  The surgeon's staff seems very reluctant to  provided me with their Pre- and Post-opt  measurements,
Please help me understand  what happened here, and my options for this LEFT eye, with the RIGHT eye to follow
Many Thanks  

[royster]

Many Thanks, SoftwareDeveloper
Being relatively grounded, and in between teaching classes, I will follow up on all your references.
In the life insurance industry, I would be an old guy with unusual health issues seeking life insurance. I would have driven the medical underwriters nuts.
Gracias..

[SoftwareDeveloper]

re: "I also paid for the in surgery option of recalibration of the measurements after the cataract was removed. "

I guess you were posting that while I was posting my prior message. That seems really puzzling then that the results could be this far off, it could be there was postop rotation of the lens for some reason. I will note that in general the issue of whether intraoperative measurements lead to better results or not is still under dispute among some surgeons (sometimes new technology takes a while to be polished to match its potential):

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery. "

http://bmctoday.net/crstodayeurope/2013/03/article.asp?f=pointcounterpoint-is-intraoperative-aberrometry-worth-the-investment
"Point/Counterpoint: Is Intraoperative Aberrometry Worth the Investment?
Surgeons weigh in on the value of this technology in cataract surgery."

Given the concern of some that the approaches aren't yet far enough along in general, I have to wonder if eyes with less common characteristics (as highly myopic eyes are) with less  data available to   calibrate things might be even more of a concern.  However the basic issue of getting lens rotation at least far closer than yours is would  I  assume be handled well enough that any issues will be minor, not like what you have.

[royster]

Many Thanks CBCT and SoftwareDeveloper.
Since my retirement in 2012, I teach actuarial math part time at UCLA, and am on break till the Fall quarter.
I am optimistic that the USC recommended bridging option of basically one eye vision will be comfortable enough to allow a timely research of all my options with multiple "vendors". I will keep you informed.
Royster

[SoftwareDeveloper]

Toric lenses are well tested (as with may things, they have been available and used longer in the rest of the world than in the US so they aren't quite as new as some might think). The results you are dealing with aren't typical.

Since you have an appointment coming up, the issue is to get them to give you more information about their diagnosis and what they plan to do about it. Depending on their answers,  if possible you might  wish to get a 2nd surgeon's opinion or to consider using another surgeon for any fixes and the other eye.  

It seems like the lens may  be rotated drastically enough to make the astigmatism worse rather than better, so the question is whether they plan to rotate it to fix that. Its also possible there is some other issue with your eye that is still healing is causing some of problem (though it seems less likely).  

One option, depending on the state of your eye is a lens exchange for one with the right power that they then hopefully insert with the correct orientation so it does correct the astigmatism, or a piggyback IOL if there is some risk with removing this lens.  There is always a risk though with any sort of surgery though. Once they decide about what to do about this lens, there still may be residual astigmatism and refractive error. Obviously you could wear glasses, or you could consider lasik or an implantable contact lens if you want a more convenient solution.  

They should explain why the lens power is off so far. It may be that the formulas used to try to guess the lens power disagreed with each other,as they sometimes do for highly myopic people.  The lens power formulas aren't exact, they are based on statistics based on how well different IOL powers have worked in other eyes in the past. There are different formulas derived from different sets of data and  different statistical methods. For most people with more average eyes the formulas will work well and tend to agree with each other, but for highly myopic people they may not for the reasons that web page I linked above describes  (in addition to the fact there is less data since fewer people are that myopic). Unfortunately not all doctors are up on the latest literature and may not be aware of the issues that the article I linked to mentions. Usually the other eye will be similar to the first in terms of its anatomy (though mine were fairly different),  so  it may be that the error in this eye can hopefully give them information to help make a better lens power choice for the second eye. As I noted, apparently Dr. Hill (and perhaps other surgeons) will consult with other surgeons on lens power choices (presumably for a fee.. though if this doctor goofed with the first lens and is involved in the 2nd one, perhaps they'd cover the fee).

It is possible that rather than being an unavoidable mistake since lens power choices aren't an exact science, that instead they made an error along the way or ordered the wrong lens. Its useful to know that to consider whether you want the same surgeon to do the other eye (even if you do stick with the same one, if it was say perhaps a staff member and not the surgeon who made an error and this will ensure they are careful next time,  if they need to admit a mistake it may lead them to be even better about trying to fix the problems to make up for it).

re: "The surgeon's staff seems very reluctant to  provided me with their Pre- and Post-opt  measurements"

That might be  a concern , perhaps suggesting they realize they made mistakes, though some doctor's staff are just not helpful so it may mean nothing. In the US you have a right to get a copy of your records, they may merely make you sign for them

[royster]

Thanks CBCT. I will follow up.
With the toric lens approach, I also paid for the in surgery option of recalibration of the measurements after the cataract was removed.
But in my particular situation, even this precaution did not help with the results beyond the removal of the cataract.
Sigh!!!

[CBCT]

Are you in Los Angeles?  Sam Maskett MD is one of the best.